David J. McGill

A direct comparison of pulsed dye, alexandrite, KTP and Nd:YAG lasers and IPL in patients with previously treated capillary malformations

Several studies have reported laser treatment of Capillary Malformations (CMs) using systems other than pulsed dye lasers (PDL). Few, however, have compared different systems in the same patients. This study aimed to directly compare CM fading using five different systems.

Air ambulance transfer of adult patients to a UK regional burns centre: Who needs to fly?

INTRODUCTION Helicopter emergency medical services play a valuable role in the transfer of critically ill patients. This paper reviews the role of air ambulance services in the provision of regional burns care and suggests guidelines for their use. METHODS A retrospective review of patients treated at the Midlands Adult Burns Centre over a 3-year period. RESULTS 27 adult burns patients were transported by air ambulance during the study period. Patients were aged 19-89 years (average 41.3 years) with an estimated burn size of 5-70% TBSA. Distance travelled was 11-79 miles (average 41.2 miles). All patients were appropriately referred to the burns centre according to national referral guidelines but in 7 cases (26%) it was felt that transport by air ambulance was not clinically indicated and land transfer would have been safe and appropriate. CONCLUSION Air ambulances offer a fast and effective means of transferring patients to a regional burns centre in selected cases. There is limited data for the beneficial effects of helicopters and survival benefit is seen only in the most severely injured patients. We suggest criteria for the use of air ambulances in burns patients in order to maximise the benefit and reduce unnecessary flights.

Validation of a semi-automated technique to accurately measure abdominal fat distribution using CT and MRI for clinical risk stratification

OBJECTIVE A valid method for accurate quantification of abdominal fat distribution (AFD) using both CT and MRI is described. This method will be primarily useful in the prospective risk stratification of patients undergoing reconstructive breast surgery. Secondary applications in many other clinical specialities are foreseen. METHODS 15 sequential patients who had undergone breast reconstruction following both CT and MRI (30 scans) were retrospectively identified at our single centre. The AFD was quantified at the level of the L3 vertebra. Image analysis was performed by at least two independent operators using free software. Intra- and interobserver differences were assessed using Bland-Altman plots. Data were validated between imaging modalities by Pearsons correlation. Linear regression analyses were used to mathematically normalize results between imaging modalities. RESULTS The method was statistically independent of rater bias (intra: Pearsons R-0.954-1.00; inter: 0.799-0.999). Strong relationships between imaging modalities were demonstrated and are independent of time between imaging (Pearsons R 0.625-0.903). Interchangeable mathematical models to normalize between imaging modality are shown. CONCLUSION The method described is highly reproducible and independent of rater bias. A strong interchangeable relationship exists between calculations of AFD on retrospective CT and MRI. Advances in knowledge: This is the first technique to be applicable to scans that are not performed sequentially or in a research setting. Analysis is semi-automated and results can be compared directly, regardless of imaging modality or patient position. This method has clinical utility in prospective risk stratification and will be applicable to many clinical specialities.

Capillary vascular malformation response to increased ambient temperature is dependent upon anatomical location

Background:It has been documented that capillary malformations (CMs) located on the limbs tend to respond less well to laser treatment than those sited on the head and neck. However, there is little evidence available to explain this observation. Objectives:To investigate potential differences between CMs located on the head and neck with those on the limbs, by comparing their response to increasing ambient temperature. Methods:Fifteen previously untreated subjects with CMs were compared as the ambient temperature was increased from 20°C to 28°C. These included 10 with head and neck CMs and 5 with limb CMs. The following measurements were taken at 2°C intervals: cutaneous blood flow, capillary diameter, density and depth, CM color, skin and core temperatures. Results:There were no statistically significant differences in mean capillary depth, diameter, density, or CM color between groups. Cutaneous blood flow increased with ambient temperature in the head and neck CMs (P = 0.009) and was significantly higher than that in the limb CMs at all temperatures (P < 0.001), while the limb CMs did not demonstrate any increase in cutaneous blood flow with temperature. Conclusions:These results suggest a possible reason for the poorer response to laser treatment seen in limb CMs: since cutaneous blood flow is a product of the blood flow velocity and hemoglobin concentration, malformations with lower blood perfusion would have less chromophore available and therefore be less suitable for laser destruction.

Monitoring of Microcirculation in Free Transferred Musculocutaneous Lattisimus Dorsi Flaps by Confocal-Laser-Scanning Microscopy – A Promising Noninvasive Methodical Approach

Confocal laser scanning microscopy (CLSM) may be used either as fluorescence or reflectance microscopy, with much of the previous work in human skin focusing on the investigation of pigmented and non-pigmented skin malignancies. Until now there has been little published on CLSM analysis of skin microvasculature in vivo, although there has been some work assessing dermal capillaries in fluorescent antibody-labelled skin biopsy specimens. Therefore the authors are to be congratulated on carrying out this early study demonstrating that reflectance CLSM has the potential to be a valuable bedside analysis tool for free flap monitoring. By employing a laser with a wavelength in the ‘optical window’ of the skin (in the near-infrared part of the spectrum there is little light absorption by the skin resulting in maximal light scattering and reflectance) the CLSM can be used to create a clear image of the epidermis and upper dermis, allowing the analysis of epidermal thickness, capillary loop diameter and capillary erythrocyte flow measured in this paper. As stated by the authors, this technique is limited to the analysis of unburied free tissue transfers with a cutaneous element, although it would be interesting to investigate whether it is possible to visualise blood flow in unburied muscle flaps. If possible, this could